[Influenza virus in pediatrics. A reason for hospitalization]. / El virus de la gripe en pediatría. Un motivo de hospitalización.

INTRODUCTION: Influenza infection in infants and children has been classically underestimated due to its non-specific symptoms, which sometimes overlap those of other respiratory viruses. Infants under 24 months are a risk group and school-aged children are a major source of influenza infection. The aim of this study was to describe the clinical and epidemiological characteristics of children hospitalized for flu, including co-infections and the differences as compared to other respiratory viruses. The effectiveness of a test for rapid diagnosis of this condition was assessed. MATERIAL AND METHODS: Prospective, descriptive study in children < 5 years of age hospitalized from 1 December 2003 to 28 February 2004 with respiratory processes or fever of unknown origin. Polymerase chain reaction (PCR) testing for influenza A (IA) and B, respiratory syncytial virus A (RSV-A) and B, and parainfluenza 1, 2 and 3 was performed in nasopharyngeal aspirate, as well as a test for rapid diagnosis of influenza. RESULTS: A total of 203 samples were included. PCR was positive for influenza in 11.3% (23/203); IA in 21 cases (20 H3N2, 1 H1N1). Co-infections were frequent (10/23), mainly IA with RSV-A. The rapid diagnostic test had a sensitivity of 45.5%. Median age of patients with flu was 4.87 months (5 days-3.5 years); 69.5% were < 24 months. Gastrointestinal symptoms were associated with fever and respiratory symptoms more often than in other viral infections (P < 0.05). Only 2.9% of patients with a recommendation for flu vaccination had received the vaccination. CONCLUSIONS: Flu is a major cause of hospitalization in infants and children, particularly those aged < 24 months. Early diagnosis of this condition may avoid unnecessary use of additional tests and antibiotics. Vaccination coverage is low; vaccination between 6 and 24 months seems advisable.

El virus de la gripe en pediatría. Un motivo de hospitalización / Influenza virus in pediatrics. A reason for hospitalization

Introducción. La gripe en pediatría ha sido clásicamente infradiagnosticada, por su clínica inespecífica y solapable con otros virus respiratorios. Los menores de 24 meses constituyen un grupo de riesgo y los escolares son una fuente importante de contagio. El objetivo de este estudio es describir la clínica y epidemiología de niños ingresados por gripe, estudiando coinfecciones y comparando con otros virus respiratorios. Se valoró la efectividad de un test de diagnóstico rápido. Material y métodos. Estudio descriptivo prospectivo en menores de 5 años hospitalizados entre el 1 de diciembre de 2003 y el 28 de febrero de 2004 por cuadro respiratorio o fiebre sin foco aparente. Se realizó reacción en cadena de polimerasa (PCR) a virus de la gripe A (IA) y B, virus respiratorio sincitial A (VRS-A) y B y parainfluenza 1, 2 y 3 en aspirado nasofaríngeo y test de diagnóstico rápido de gripe. Resultados. Se incluyeron 203 muestras, siendo la PCR positiva a virus de la gripe en un 11,3% (23/203): IA 21 casos (20 H3N2, 1 H1N1). Las coinfecciones fueron frecuentes (10/23), destacando la asociación IA y VRS-A. El test de diagnóstico rápido tuvo una sensibilidad del 45,5%. La mediana de edad de los pacientes con gripe fue 4,87 meses (5 días-3,5 años); un 69,5% eran menores 24 meses. A la fiebre y síntomas respiratorios, asociaron síntomas gastrointestinales con más frecuencia que los otros virus (p < 0,05). Sólo un 2,9% de los pacientes con indicación de vacunación antigripal la había recibido. Conclusiones. La gripe es causa importante de hospitalización en pediatría, especialmente en menores 24 meses. Su diagnóstico precoz evitaría el uso innecesario de pruebas complementarias y antibióticos. Existe una baja cobertura vacunal. Sería interesante la vacunación entre los 6 y los 24 meses (AU)

Introduction. Influenza infection in infants and children has been classically underestimated due to its non-specific symptoms, which sometimes overlap those of other respiratory viruses. Infants under 24 months are a risk group and school-aged children are a major source of influenza infection. The aim of this study was to describe the clinical and epidemiological characteristics of children hospitalized for flu, including co-infections and the differences as compared to other respiratory viruses. The effectiveness of a test for rapid diagnosis of this condition was assessed. Material and methods. Prospective, descriptive study in children < 5 years of age hospitalized from 1 December 2003 to 28 February 2004 with respiratory processes or fever of unknown origin. Polymerase chain reaction (PCR) testing for influenza A (IA) and B, respiratory syncytial virus A (RSV-A) and B, and parainfluenza 1, 2 and 3 was performed in nasopharyngeal aspirate, as well as a test for rapid diagnosis of influenza. Results. A total of 203 samples were included. PCR was positive for influenza in 11.3% (23/203); IA in 21 cases (20 H3N2, 1 H1N1). Co-infections were frequent (10/23), mainly IA with RSV-A. The rapid diagnostic test had a sensitivity of 45.5%. Median age of patients with flu was 4.87 months (5 days-3.5 years); 69.5% were < 24 months. Gastrointestinal symptoms were associated with fever and respiratory symptoms more often than in other viral infections (P < 0.05). Only 2.9% of patients with a recommendation for flu vaccination had received the vaccination. Conclusions. Flu is a major cause of hospitalization in infants and children, particularly those aged < 24 months. Early diagnosis of this condition may avoid unnecessary use of additional tests and antibiotics. Vaccination coverage is low; vaccination between 6 and 24 months seems advisable (AU)

Peritonitis plástica miliar y fístula estercorácea / Miliary plastic peritonitis and stercoraceous fistula

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Infección perinatal por el VIH-1 en un niño sin formación de anticuerpos anti-VIH-1 / Perinatal HIV-1 infection in a child without HIV- antibody formation

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Un caso de paludismo neonatal en España / A case of neonatal malaria in Spain

Exponemos un caso de paludismo neonatal nacido en España. Se trata de una recién nacida cuya madre había vivido los primeros 8 meses de embarazo en Guinea Ecuatorial. Nuestra paciente, encontrándose previamente bien, en la tercera semana de vida inició fiebre en pico, de predominio matutino sin otra sintomatología asociada salvo palidez. Mantuvo un buen estado general en todo momento. En las pruebas complementarias destacamos: anemia y trombopenia; en el examen del frotis sanguíneo se evidenció parasitación por Plasmodium falciparum. El tratamiento con mefloquina fue efectivo, negativizándose el frotis al octavo día y normalizándose progresivamente el hemograma. El presente artículo sugiere que el paludismo neonatal debe considerarse en aquellos recién nacidos en losque se sospeche infección congénita, que hayan nacido de mujeres con antecedentes de viajes o que hayan emigrado de zonas endémicas. Así mismo destacamos que la presentación clínica del paludismo en el período neonatal es totalmente inespecífica e indistinguible de otras infecciones congénitas (AU)

We report a case of neonatal malaria born in Spain. It is about a female newborn whose mother lived the first eight months of her pregnancy in Ecuatorial Guinea. Althogh our patient was well, in the third week of her life she developed fever mostly in mornings without any other symtoms except pallor. She kept a good physicalstate in any moment. In complementary proves we remark: anaemia and thrombocytopenia; as well Plasmodium falciparum was found in blood smears. Treatment with mefloquine was successfully, blood smears was negative of parasites in the eighth day andhemogram was restoring normal. This article suggests neonatal malaria must be considered in those newborns suspected congenital infection born from mothers who have travelled to risk countries or inmigrated from endemic areas. Also we remark that malaria clinic developement in newborns is nonspecific and indistinguishable from other congenital infections (AU)